Neurological deterioration in small vessel disease may be associated with increase of infarct volume
Neurological deterioration in small vessel disease may be associated with increase of infarct volume
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DOI：
10.1016/j.jns.2007.12.014
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发表时间：
2008-06-15
影响因子：
4.4
通讯作者：
Kaji, Ryuji
中科院分区：
文献类型：
--
作者：
Terasawa, Yuka;Iguchi, Yasuyuki;Kaji, Ryuji
背景与目的：小血管疾病神经功能恶化的机制尚不清楚。我们研究了急性小血管疾病中神经功能恶化与梗死体积变化之间的关系。方法：我们研究了连续的急性幕上小血管疾病患者。患者被分为两组（D：恶化组，N：未恶化组）。我们进行了系列 MRI 研究，使用 NIH Image 测量了梗塞体积，并计算了初始和后续扩散加权成像 (DWI) 之间梗塞体积 (Delta 体积) 的变化。结果：纳入了 72 名患者（44 名男性，68 +/- 11 岁）。 15 名患者表现出神经功能恶化（D 组），57 名患者没有表现出神经功能恶化（N 组）。 D 组的初始梗塞体积为 0.66 cm(3)，N 组的初始梗塞体积为 0.45 cm(3) (p=0.025)。随访 DWI 梗死体积分别为 1.41 cm(3) 和 0.72 cm(3) (p=0.001)。 D 组的 Delta 体积大于 N 组（0.76 cm(3) vs 0.27 cm(3)，p=0.001）。为了区分D组和N组，敏感性特异性分析得出了区分两组的Delta体积截断值为0.5cm(3)，其敏感性为80%，特异性为84%。多变量logistic回归分析表明，梗塞体积增加超过0.5 cm(3)（比值比；18.0，95% CI；1.4至270，p = 0.027）与急性小血管疾病患者的神经功能恶化独立相关。结论：梗死体积的扩大可能导致急性小血管疾病患者的神经功能恶化。 (C) 2007 Elsevier B.V. 保留所有权利。
Background and purpose: The mechanism of neurological deterioration in small vessel disease is unclear. We examined the relationship between neurological deterioration and change of infarct volume in acute small vessel disease.Methods: We studied consecutive patients with acute supratentorial small vessel disease. Patients were classified into two groups (D: group with deterioration, N: group with no deterioration). We performed serial MRI studies, measured infarct volumes using NIH Image, and calculated the changes in infarct volume (Delta volume) between initial and follow-up diffusion-weighted imaging (DWI).Results: Seventy-two patients (44 males, 68 +/- 11 years of age) were enrolled. Fifteen patients exhibited neurological deterioration (group D) and 57 patients did not (group N). Initial infarct volume was 0.66 cm(3) in group D and 0.45 cm(3) in group N (p=0.025). Infarct volumes on follow-up DWI were 1.41 cm(3) and 0.72 cm(3), respectively (p=0.001). The Delta volume in group D was larger than that in group N (0.76 cm(3) vs 0.27 cm(3), p=0.001). In order to differentiate D from N group, sensitivity specificity analysis yielded a cut-off value of Delta volume of 0.5 cm(3) for differentiation of the two groups, which exhibited a sensitivity of 80% and specificity of 84%. Multivariate logistic regression analysis demonstrated that increase in infarct volume of over 0.5 cm(3) (odds ratio; 18.0, 95% CI; 1.4 to 270, p = 0.027) was independently associated with neurological deterioration in patients with acute small vessel disease.Conclusions: Enlargement of infarct volume may contribute to neurological deterioration in acute small vessel disease. (C) 2007 Elsevier B.V. All rights reserved.